| Entity Name: | MILLER CHIROPRACTIC AND WELLNESS INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Jun 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 20 Oct 2016 (8 years ago) |
| Document Number: | P05000091393 |
| FEI/EIN Number | 203106638 |
| Address: | 1228 66TH STREET NORTH, SAINT PETERSBURG, FL, 33710, US |
| Mail Address: | 1228 66TH STREET NORTH, SAINT PETERSBURG, FL, 33710, US |
| ZIP code: | 33710 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982621314 | 2006-07-15 | 2013-07-02 | 1228 66TH STREET N, ST PETERSBURG, FL, 337106226, US | 1228 66TH STREET N, ST PETERSBURG, FL, 337106226, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 727-384-6168 |
| Fax | 7273846158 |
Authorized person
| Name | JASON DONALD MILLER |
| Role | PHYSICIAN |
| Phone | 7273846168 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH8123 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 382042400 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | K9133 |
| State | FL |
| Issuer | BCBS |
| Number | 60949 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MILLER JASON D | Agent | 1228 66TH STREET NORTH, SAINT PETERSBURG, FL, 33710 |
| Name | Role | Address |
|---|---|---|
| JASON MILLER D | President | 1228 66TH STREET NORTH, SAINT PETERSBURG, FL, 33710 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2017-03-23 | 1228 66TH STREET NORTH, SAINT PETERSBURG, FL 33710 | No data |
| REINSTATEMENT | 2016-10-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-01-12 | MILLER, JASON D | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-03-31 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-03-23 |
| REINSTATEMENT | 2016-10-20 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
